Cataract Surgery Practice in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2020

Purpose@#To describe current cataract surgery practice patterns and trends among Korean ophthalmologists. @*Methods@#A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys. @*Results@#The largest percentage of respondents (39%) had 11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks. @*Conclusions@#This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.

Cataract Surgery Practice in the Republic of Korea: A Survey of the Korean Society of Cataract and Refractive Surgery 2020

Purpose@#To describe current cataract surgery practice patterns and trends among Korean ophthalmologists. @*Methods@#A survey was conducted among members of the Korean Society of Cataract and Refractive Surgery in October 2020. Of the 998 questionnaires, 262 (26.3%) were received for analysis. Data were analyzed using descriptive statistics and compared with those of previous surveys. @*Results@#The largest percentage of respondents (39%) had 11 years of practical experience. The average, median, and mode monthly volumes of cataract surgeries performed by the Korean Society of Cataract and Refractive Surgery members were 31, 20, and 10 cases, respectively. Topical anesthesia was administered by 85% of the respondents. For intraocular lens (IOL) calculations, 96% of the respondents used optical biometry. The proportion of surgeons providing femtosecond laser-assisted cataract surgery increased significantly from 5% in 2018 to 29% in 2020. This increase was accompanied by an increase in the multifocal IOLs. Those who implant multifocal IOL for >10% of their cases increased from 16% (2018) to 29% (2020). Topical nonsteroidal anti-inflammatory drugs were prescribed postoperatively by 76% of the respondents. Most respondents (70%) prescribed these anti-inflammatory drugs for 4 weeks. @*Conclusions@#This survey provided a comprehensive update on current cataract surgery practice in the Republic of Korea. The results highlighted the increasing use of premium IOLs, femtosecond laser-assisted cataract surgery, optical biometry, and topical anesthesia to better meet the patients’ needs.

Clinical Results of Femtosecond Laser-assisted Cataract Surgery in Eyes with Posterior Chamber Phakic Intraocular Lens

Purpose@#To investigate the clinical results of femtosecond laser-assisted cataract surgery (FLACS) in eyes previously implanted with a posterior chamber phakic intraocular lens (PIOLs). @*Methods@#The medical records of 27 eyes were retrospectively reviewed. Each eye had history of implantation of posterior chamber PIOLs and newly got FLACS. Complications of intraoperative anterior capsulotomy and lens fragmentation were investigated. Uncorrected and corrected visual acuities (UCVA and BCVA), keratometric and manifest refraction (MR) values were compared preoperatively and postoperatively 1 day, 2 months and 6 months. @*Results@#All eyes completed anterior capsulotomy without any intraoperative complication. However, 13 eyes out of 18 eyes experienced incomplete lens fragmentation. Vaultings of 5 eyes with complete lens fragmentation were 460.40 ± 199.11 μm (0.84 ± 0.35 corneal thickness [CT]) and vaultings of the other 13 eyes with incomplete lens fragmentation were 225.85 ± 151.2 μm (0.43 ± 0.29 CT). 2 eyes with vaultings of 460 μm and 412 μm failed to complete lens fragmentation due to corneal opacity. All eyes could be completed whole surgery without additional complications. @*Conclusions@#FLACS in eyes with posterior chamber PIOLs is useful to execute anterior capsulotomy. However, there is a limitation in doing lens fragmentation because of bubble accumulated under PIOLs.

Long-term Results of Arcuate Keratotomy in Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To investigate the long-term follow-up results of arcuate keratotomy in femtosecond laser-assisted cataract surgery. METHODS: The medical records of 78 patients (99 eyes) with corneal astigmatism >0.5 diopters (D) who underwent arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery were retrospectively reviewed. Uncorrected and corrected visual acuities and keratometric and higher order aberration outcomes were compared preoperatively and 2 years postoperatively. RESULTS: The mean uncorrected visual acuities and corrected visual acuities changed from 0.55 ± 0.31 D and 0.33 ± 0.26 D, preoperatively to 0.13 ± 0.19 D and 0.07 ± 0.09 D, 2 years postoperatively. The mean preoperative corneal astigmatism was −1.15 ± 0.66 D. This was reduced to −0.79 ± 0.38 D at 1–2 days after surgery (p < 0.001), followed by no significant change for 2 years. The mean target-induced astigmatism was 1.15 ± 0.66 D preoperatively, and the mean surgically-induced astigmatism and difference vector were 0.69 ± 0.43 D and 0.83 ± 0.48 D, 2 years postoperatively. The mean correction index was 0.68 ± 0.45, 2 years postoperatively. There was no significant difference in higher order aberrations except 4 mm and 6 mm total higher order aberrations and 6 mm trefoil between preoperatively and 2 years postoperatively. CONCLUSIONS: Arcuate keratotomy concurrent with femtosecond laser-assisted cataract surgery is a safe and effective way to reduce corneal astigmatism which remained stable over 2 years of follow-up with below moderate astigmatism.

Possible Risk Factors Affecting Successful Femtosecond Laser-assisted Cataract Surgery

PURPOSE: To determine the risk factors of intraoperative complications in femtosecond laser-assisted cataract surgery. METHODS: This study included 598 eyes of 337 patients who underwent femtosecond laser-assisted cataract surgery (FLACS) between July, 2012 and January, 2017. All eyes had corneal incisions, anterior capsulotomy, nuclear fragmentation, and limbal relaxing incisions (if required). Intraoperative complications were analyzed by watching videos, and the related factors of each complication were retrospectively reviewed alongside the medical records. RESULTS: The mean age of the patients was 62.1 ± 11.9 years. Among the study group, 18 eyes required manual creation of corneal incisions; because the corneal incisions could not be made due to corneal central opacity, corneal peripheral degeneration, ptreygium, conjunctival chalasis, or idiopathic. The anterior capsulotomy was incomplete in 43 cases and manual capsulorrhexis was required for completion. These cases were associated with various conditions, including hypermature cataract, anterior polar or subcapsular cataract, corneal central opacity, pupillary abnormality, lens subluxation, poor pupil dilation, and idiopathic. Overall, 22 eyes had difficulties with nuclear fragmentation, with either mature cataract, lens subluxation, corneal central opacity, anterior polar or subcapsular cataract, or pupillary abnormality. Using the Laser SoftFit™ patient interface decreased the incidences of incomplete corneal incision (from 3.56% to 2.24%, p = 0.367), anterior capsulotomy (from 9.31% to 4.03%, p < 0.05), and nuclear fragmentation (from 5.20% to 1.34%, p < 0.05). The incidences of complications in the experienced group was statistically lower compared with the novice group (p < 0.05 for all comparisons). CONCLUSIONS: The femtosecond laser platform was effective and safe for cataract surgery. However, in the presence of related factors, use of this platform might need to be re-assessed and should be considered for intraoperative complications. Additionally, with the Laser SoftFit™ patient interface and improved surgeon experience, better intraoperative results can be expected for FLACS surgery.

Comparison of Refractive Power and Astigmatism between Digital Keratometer and Autorefractor

PURPOSE: To compare the corneal refraction, astigmatism, and corneal marking for toric intraocular lens measured with a VERION® Image Guided System and an autorefractor in order to precisely determine the toric intraocular lens target. METHODS: The medical records of 29 eyes of 29 patients were retrospectively reviewed to compare the corneal refraction, axis, and amount of astigmatism measured with a VERION® Image Guided System and an autorefractor. We compared the difference in marked axis for toric intraocular lenses as measured by a VERION Digital Marker and a manual marker. RESULTS: The average corneal refraction and amount of astigmatism were greater with the VERION® Image Guided System than with the autorefractor. The average difference in axis of astigmatism was 9.62°. The difference in axis of astigmatism in patients with more than 1.0 D of astigmatism (18 eyes) was 2.82 ± 2.27°, while that in patients with less than 1.0 D of astigmatism (11 eyes) was 20.27 ± 28.14°. The average difference in marked axis for toric intraocular lens measured by the VERION® Digital Marker and manual marker was 2.50° (0°-9.27°). CONCLUSIONS: The corneal refraction and amount of astigmatism were significantly higher with the VERION® Image Guided System, so careful concern and comparison of surgical outcomes between the two devices is needed in biometry.

Comparison of Effective Phacoemulsification Time between Femtosecond Laser-Assisted Cataract Surgery and Conventional Cataract Surgery

PURPOSE: To compare the effect of femtosecond laser-assisted cataract surgery with conventional cataract surgery on effective phacoemulsification time (EPT). METHODS: This study included 66 patients 100 eyes who underwent femtosecond laser-assisted cataract surgery and 68 patients 100 eyes who underwent conventional cataract surgery. Both groups underwent phacoemulsification using pulsed ultrasound energy and EPT was evaluated. The groups were further analyzed according to preoperative Lens opacities classification system (LOCS) III grading. Patients who had femtosecond laser-assisted cataract surgery underwent lens fragmentation with quadrant, hybrid, or grid pattern and the EPT was respectively evaluated. RESULTS: The mean EPT was 5.85 +/- 4.31 seconds in the femtosecond laser-assisted cataract surgery group and 10.34 +/- 6.61 seconds in the conventional group. Overall, EPT was statistically significantly lower in the femtosecond laser-assisted cataract surgery group compared to the conventional group. When the groups were analyzed according to LOCS III grading, this result was consistent for all cataract grades and the reduction in EPT was increased with the higher LOCS III grade. When the groups were analyzed according to lens fragmentation patterns, the mean EPT was lower with 350 microm grid pattern than the quadrant or hybrid pattern. CONCLUSIONS: The femtosecond laser-assisted system in cataract surgery can be an efficient cataract surgery using lower EPT compared to the conventional procedure. Additionally, significant differences were observed in the mean EPT of cataract surgery using the femtosecond laser-assisted system among the 3 lens fragmentation pattern groups.

Stand-Alone Cages for Anterior Cervical Fusion: Are There No Problems?

OBJECTIVE: There are complications in stand-alone cage assisted anterior cervical discectomy and fusion (ACDF), such as cage subsidence and kyphosis. Here we report our clinical result on ACDF, comparing with stand-alone cages and with cervical plate system for degenerative cervical spine diseases. METHODS: Patients with degenerative cervical disease who were diagnosed and treated in Konyang University Hospital between January 2004 and December 2014 were included in this study. Patients who had operation in single level ACDF were selected. Patients scored the degree of pain using visual analog scale before and after the surgery. Subsidence was defined as ≥3-mm decrease of the segmental height, and cervical kyphosis was defined as progression of ≥5° at 12 months after postoperative follow-up compared to that measured at the immediate postoperative period. RESULTS: A total of 81 patients were enrolled for this study. Forty-five patients were included in a cervical plate group and the others were in stand-alone cage group. There was no statistical difference in pain score between the 2 groups. Segmental subsidence was observed in 7 patients (15.6%) in plate-assisted cervical fusion group, and 13 patients (36.1%) in stand-alone cage group. Segmental kyphosis was observed in 4 patients (8.9%) in plate-assisted cervical fusion group, and 10 patients (27.8%) in stand-alone cage group. There was statistical difference between the 2 groups. CONCLUSION: There was no difference in pain between 2 groups. But stand-alone case group showed higher incidence rate than plate-assisted cervical fusion group in segmental subsidence and cervical kyphosis. When designing cervical fusion, more attention should be given selecting the surgical technique.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

PURPOSE: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. METHODS: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR(R) SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. RESULTS: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 +/- 0.19, and 0.19 +/- 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within +/-0.50 diopters (D) and all eyes were within +/-1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 +/- 0.08 and 0.07 +/- 0.07 (microm), respectively. Objective scatter index was 3.42 +/- 1.71 and modulation transfer function (MTF) cut-off value was 21.03 +/- 12.37 cpd. General satisfaction score was 3.52 +/- 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. CONCLUSIONS: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor.

Comparison of Laser Refractive Cataract Surgery with a Femtosecond Laser Versus Conventional Phacoemulsification

PURPOSE: To evaluate the surgical results and efficacy of laser refractive cataract surgery with a femtosecond laser compared with conventional phacoemulsification. METHODS: Thirty-one eyes from 31 patients underwent laser refractive cataract surgery (femtosecond laser group), and conventional cataract surgery with phacoemulsification was performed in 30 eyes from 30 patients (conventional group). Best corrected visual acuity, spherical equivalent, surgical induced astigmatism, corneal and ocular astigmatism, total high order aberration, Strehl ratio, objective scatter index, diameter of continuous curvilinear capsulorrhexis (CCC), distance from visual axis to the center of CCC, intraocular lens (IOL) tilt, mean absolute error, effective phaco time, average phaco power and operation time were measured to compare the 2 groups. RESULTS: No significant differences were found between best corrected visual acuity, spherical equivalent, surgical induced astigmatism, corneal and ocular astigmatism, total high order aberration, Strehl ratio, objective scatter index, mean absolute error, effective phaco time, average phaco power or operation time. Significant differences were found in the diameter of CCC, distance from visual axis to the center of CCC, and IOL tilt. CONCLUSIONS: Results of laser refractive cataract surgery with a femtosecond laser showed more precise CCC, and more stable IOL position than conventional cataract surgery.

The Efficacy of KR-1W Aberrometer in Assessing the Astigmatism after Toric Intraocular Lens Implantation

PURPOSE: To evaluate the efficacy of the KR-1W aberrometer in assessing the astigmatism and the achieved axis after AcrySof Toric intraocular lens (IOL) implantation. METHODS: Thirty-nine patients (48 eyes) that had undergone phacoemulsification and AcrySof Toric IOL implantation were included in the present study. At postoperative 1 month, ocular aberrations of all the eyes were measured using the KR-1W aberrometer before mydriasis and the achieved axis of AcrySof Toric IOL was measured by slit lamp examination after mydriasis. The achieved axis measured by slit lamp examination and the astigmatism of the implanted AcrySof Toric IOL were compared with the KR-1W. RESULTS: The mean achieved lens axis after mydriasis measured by slit lamp examination and KR-1W was 86.43 +/- 47.49 degrees and 88.93 +/- 41.22 degrees, respectively. The correlation coefficient of the 2 methods was 0.992 (p < 0.001). The measured astigmatism according to the AcrySof Toric IOL model was 1.11 +/- 0.47D in SN60T3, 1.71 +/- 0.51D in SN60T4, and 3.32 +/- 0.78D in SN60T5. CONCLUSIONS: Without the need to directly evaluate the axis of implanted Toric IOL after mydriasis, the achieved lens axis can be measured by the KR-1W without mydriasis. The AcrySof Toric IOL model could be assessed by the KR-1W without information about the AcrySof Toric IOL model.

Intraindividual Comparison of ICL and Toric ICL Implantation in the Correction of High Myopia With Astigmatism

PURPOSE: We compared intra-individual visual outcomes and patient satisfaction after implantable contact lens (ICL) and Toric ICL implantation. METHODS: Twenty-eight eyes of 14 patients were enrolled in this retrospective study. One eye of each patient was assigned to ICL (ICL Group), and the contralateral eye was allocated to Toric ICL (Toric ICL Group). All patients were examined for visual acuity, refraction, intraocular pressure, slit lamp measurements, and satisfaction one week, one month, two months, and six months postoperatively. RESULTS: Mean spherical equivalents of the two groups were corrected from -7.83D (ICL Group) and -5.55D (Toric ICL Group) to 0.13D and 0.20D, respectively, and the mean refractive cylinders were corrected from 0.92D and 2.60D to 0.42D and 0.27D, respectively, at six months postoperatively. The myopias of these two groups and the astigmatism of the Toric ICL group were effectively corrected. The uncorrected visual acuity (UCVA) of the two groups were 1.02 and 1.05, respectively, at six months postoperatively. The safety index, efficacy index, predictability, and stability were favorable. There were no significant differences between the two groups in terms of postoperative UCVA, intraocular pressure(IOP), vaulting, noticeable complications, or patient satisfaction. CONCLUSIONS: The results show ICL implantation is effective treatment for high myopia, and Toric ICL implantation is a viable surgical option for the treatment of compound myopia astigmatism. Selection of proper phakic intraocular lens(IOL) is recommended for correcting astigmatism.

Long Term Effect of ICL Implantation to Treat High Myopia

PURPOSE: We have investigated the long term effect, stability, predictability and complication of ICL implantation to treat high myopia. METHODS: We investigated retrospectively in 176 eyes of 97 patients with spherical equivalent -11.91D (-6D~-23D) that were followed up for at least 6 months after ICL implantation. RESULTS: Mean spherical equivalent was maintained stable as -0.54D at 1 week post-operatively, and at -0.55D for 5years. There was high effect and predictability, with 92.3% of the eyes exhibiting a greater than or equal to best corrected visual acuity (BCVA), 83% of eyes having a post-operative uncorrected visual acuity (UCVA) of 0.5 or better, 91.3% having a post-operative refraction of -1.0D~+1.0D, and 86.4% having a post-operative refraction of -0.5D~+0.5D. The most common complications were glare and halos. With a temporary increase in IOP, significant endothelial cell loss was observed. Repositioning for a dislocated ICL was done in 3 eyes. Post-operative cataracts were found in 7 eyes (3.9%), which was a significant increase in incidence, but not surprising, as the patients were older and had lower Vaulting values. CONCLUSIONS: ICL implantation to treat high myopia was an effective surgery with good predictability and stability, and effective in both short term and long term follow-up periods.

Medial Canthal Reconstruction with Bilobed Flap

PURPOSE: We report 2 cases treated with bilobed flap surgery for medial canthal reconstruction. METHODS: Two patients with black and painless lid mass, 1 x 1 cm size, developed at medial canthal area were excised, and medial canthal reconstruction was performed. Biopsy was done before the surgery, showing basal cell carcinoma. We designed and rotated bilobed flap to reconstruct medial canthal defect caused by the radical excision, and sutured it at the incision margin of the skin. RESULTS: Pathologic examination was done after the surgery, confirming basal cell carcinoma. No marginal cancer cell were detected. Cancer relapse did not occur during 12 months of follow-up. We obtained satisfactory results in all patients, not only clinically but also cosmetically. CONCLUSIONS: It is considered that the bilobed flap procedure is effective for reconstruction of medial canthal defect developed after eyelid tumor excision and offer a good prognosis.

Purtscher-like Retinopathy after Scleral Fixation of IOL

PURPOSE: We report a case of Purtscher-like retinopathy following the removal of a dislocated IOL and scleral fixation of a new IOL. METHODS: A 60-year-old man presented with sudden visual loss of the right eye. An ophthalmologic examination revealed IOL dislocation. He underwent removal of the dislocated IOL and scleral fixation of the new IOL. Visual acuity was 0.02 in the right eye on the second postoperative day. A fundus examination and fluorescein angiography were performed. RESULTS: A peripapillary multiple cotton wool spot, pale macula and cherry red spot were noted in the right eye. Fluorescein angiography showed arteriolar obstruction around the macula and leakage of the mild arteriolar fluorescein dye. At one month follow-up, macular edema, hemorrhage and peripapillary cotton wool spots were increased. CONCLUSIONS: This case of Purtscher-like retinopathy following scleral fixation of the IOL did not have any obvious etiologic cause.

Comparative effects of curcuminoids on endothelial heme oxygenase-1 expression: ortho-methoxy groups are essential to enhance heme oxygenase activity and protection

Recently, it has been reported that curcumin, which is known as a potent antioxidant, acts as a non-stressful and non-cytotoxic inducer of the cytoprotective heme oxygenase (HO)-1. In this study, naturally occurring curcuminoids, such as pure curcumin, demethoxycurcumin (DMC) and bis-demethoxycurcumin (BDMC), were compared for their potential ability to modulate HO-1 expression and cytoprotective activity in human endothelial cells. All three curcuminoids could induce HO-1 expression and HO activity with differential levels. The rank order of HO activity was curcumin, DMC and BDMC. In comparison with endothelial protection against H2O2-induced cellular injury, cytoprotective capacity was found to be highest with curcumin, followed by DMC and BDMC. Interestingly, cytoprotective effects afforded by curcuminoids were considerably associated with their abilities to enhance HO activity. Considering that the main difference among the three curcuminoids is the number of methoxy groups (none for BDMC, one for DMC, and two for curcumin), the presence of methoxy groups in the ortho position on the aromatic ring was suggested to be essential to enhance HO-1 expression and cytoprotection in human endothelial cells. Our results may be useful in designing more efficacious HO-1 inducers which could be considered as promising pharmacological agents in the development of therapeutic approaches for the prevention or treatment of endothelial diseases caused by oxidative damages.

Subconjunctival Sparganosis

PURPOSE: The subconjunctival sparganosis is rare tissue helminthiasis which developed frequently in abdominal, urethral, ureteral and vertebral cases. Authors report a case of sparganosis in the subconjunctival mass. METHODS: A 51-year-old man with reddish non painful mass in his left eye on the subconjunctiva that was unresponsive to medications for 6months was evaluated and treated surgically. On surgical exploration, a white thread-like plerocercoid 0.2 x 4.7 cm in size was extracted from the subconjunctival mass and actively motile in the bottle filled with saline. It was confirmed as a typical sparganum under histologic examination. Three months after surgery, the lesion disappeared completely. RESULTS: Although rare, parasitic disease should be suspected in a palpable subconjuntival mass unresponsive to the medical treatment.

Clinical Study of Angiotensin Converting Enzyme Inhibitor and Angiotensin II Receptor Antagonist Combination Therapy in Renal Patients / 대한신장학회잡지

BACKGROUND: Angiotensin-converting enzyme inhibitors(ACEi) do not decrease plasma angiotensin II levels in chronic use to the same extent as in acute use. this reincrease in angiotensin II level is explained either by a renin-mediated reactive rise in plasma angiotensin I or by non-ACE dependent angiotensin II generation. The aim of this study was to compare the additive effects of an ACEi and angiotensin II receptor antagonist(AT1a) in antiproteinuric effect, hyperkalemia, and hypotension. METHODS: 58 outpatients with chronic renal insufficiency were included and they were randomly classified into two groups : Group I(prescribed AT1a only), Group II(AT1a and ACEi combination therapy), and the changes of serum creatinine, the amount of proteinuria, the developement of hyperkalemia, and hypotension were evaluated. RESULTS: In group I, the amount of proteinuria decreased to 92.8% of initial amount at 1 month after the start of drugs. 2 of 28 patients(7.1%) developed hyperkalemia, and serum creatinine did not change (1.686+/-1.415mg/dL 1.821+/-1.301mg/dL, p=0.289). But in combination therapy group, serum creatinine level increased from baseline value of 1.466+/-0.619mg/dL to 1.800+/-0.881mg/dL(p=0.05), proteinuria did not change (101% of initial amount), and 7 of 30 patients(23.3%) developed hyperkalemia. CONCLUSION: Combination therapy seems to have no additive antiproteinuric effect, but serum creatinine and potassium levels should be closely monitered during the combination therapy.

-Melanocyte Stimulating Hormone (MSH) decreases cyclosporine A induced apoptosis in cultured human proximal tubular cells

The pathogenesis of chronic cyclosporine A (CsA) nephrotoxicity has not been elucidated, but apoptosis is thought to play an important role in CsA induced tubular atrophy. Recently Fas-Fas ligand system mediated apoptosis has been frequently reported in many epithelial cells as well as in T lymphocytes. We investigated the ability of CsA to induce apoptosis in cultured human proximal tubular epithelial cells and also the effect of -MSH on them. Fas, Fas ligand, and an intracellular adaptor protein, Fas-associating protein with death domain (FADD) expression, and poly-ADP ribose polymerase (PARP) cleavage were also studied. CsA induced apoptosis in cultured tubular epithelial cells demonstrated by increased number of TUNEL positive cells and it was accompanied by a significant increase in Fas mRNA and Fas ligand protein expressions. FADD and the cleavage product of PARP also increased, indicating the activation of caspase. In -MSH co-treated cells, apoptosis markedly decreased with downregulation of Fas, Fas ligand and FADD expressions and also the cleavage product of PARP. In conclusion, these data suggest that tubular cell apoptosis mediated by Fas system may play a role in tubular atrophy in chronic CsA nephrotoxicity and pretreatment of -MSH may have a some inhibitory effect on CsA induced tubular cell apoptosis.